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Prognostic value of systematic lymphadenectomy in patients with ovarian cancer: A systematic review and meta-analysis
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  • AlBatool AlMahdy,
  • Gena Elassall,
  • Ahmed Abdelbadee,
  • Ahmed Yassien Abd-Elkariem,
  • Fatma Atef,
  • Islam Ahmed,
  • Esraa Sayed,
  • Mohamed Ashraf,
  • Ahmed Ali,
  • Esraa Ragab,
  • Hossam Aldein Abd Elazeem,
  • Mahmoud Saad,
  • Sherif Shazly
AlBatool AlMahdy
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Gena Elassall
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Ahmed Abdelbadee
Assiut University
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Ahmed Yassien Abd-Elkariem
Assiut University
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Fatma Atef
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Islam Ahmed
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Esraa Sayed
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Mohamed Ashraf
Assiut University Faculty of Medicine
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Esraa Ragab
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Hossam Aldein Abd Elazeem
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Mahmoud Saad
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Sherif Shazly
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Abstract

Background: Standard management of ovarian cancer is surgical debulking and adjuvant chemotherapy. The role of systematic lymphadenectomy, as a part of debulking, has been controversial. Objective: To assess prognostic value of systematic lymphadenectomy in women with ovarian cancer based on stage, control group and type of chemotherapy Search strategy: A literature search was conducted on SCOPUS, PUBMED, COCHRANE, MEDLINE, and WEB OF SCIENCE databases. Selection criteria: All comparative studies that assess outcomes of systematic lymphadenectomy in patients with ovarian cancer were eligible. Data Collection and Analysis: overall survival was analyzed by pooling log hazard ratio (HR) and standard error of multivariable Cox regression models. MOGGE Meta-analysis Matrix is a novel illustration tool that was used to demonstrate multiple subgroup analyses of included studies. Main results: Twenty-two studies were eligible. Systematic lymphadenectomy was associated with better overall survival, that was close to significance, compared to control group (HR 0.93, 95%CI 0.86-1.00). Among women treated with adjuvant chemotherapy, overall survival improved in women with stage IIB-IV who underwent systematic lymphadenectomy (HR 0.91, 95%CI 0.84-0.99) and was most significant among patients with III to IV (HR 0.85, 95%CI 0.73-0.99). Systematic lymphadenectomy did not improve survival in women who received neoadjuvant chemotherapy (HR 0.97, 95%CI 0.73-1.29). Systematic lymphadenectomy was associated with improved progress-free survival compared to control group (HR 0.88, 95%CI 0.79-0.99). Conclusion: Data from clinical trials do not support role of systematic lymphadenectomy in advanced ovarian cancer. However, further studies may be warranted to assess substage-specific survival outcomes in women with advanced stages.